Ranitidine Antacids

The application of the so-called pH-partition hypothesis and its limitations should be understood, so that the effects of the nature of the drug and the medium on absorption can be assessed. In the case of the oral route, the effect of concomitant medication (cimetidine, ranitidine, antacids, etc.), which might alter the pH of the gut contents, can be approximated by calculating the change in the drug ionisation. 

When administered with ranitidine, alendronate bioavailability is increased. When calcium supplements or antacids are administered with risedronate or alendronate, absorption of the bisphosphonates is decreased, hi addition, risedronate absorption is inhibited when the drug is administered with magnesium and aluminum. There is an increased risk of gastrointestinal... 

Dofetilide is not administered with cimetidine because dofetilide plasma levels may be increased by as much as 50%. When treatment for gastric disorders is necessary, patients receiving dofetilide should take omeprazole ranitidine, or antacids as an alternative to cimetidine. 

The following drugp have a decreased pharmacologic effect when administered with an antacid corticosteroids, digoxin, chlorpromazine, oral iron products, isoniazid, phenothiazines, ranitidine, phenytoin, valproic acid, and the tetracyclines. 

HISTAMINE H2 ANTAGONISTS. The nurse administers ranitidine and oral cimetidine before or with meals and at bedtime Nizatidine and famotidine are given at bedtime or, if twice-a-day dosing is prescribed, in the morning and at bedtime. These drugp are usually given concurrently with an antacid to relieve the pain. In certain situations or disorders, cimetidine and ranitidine may also be given by intermittent IV infusion or direct IV injection. 

Antacid/alginic acid (Gaviscon) 2 tablets or 1 5 mL after meals and at bedtime AND/OR C. Patient-directed therapy Over-the-counter H2RAs (each taken up to twice daily) - Cimetidine 200 mg - Lamotidine 1 0 mg - Nizatidine 75 mg - Ranitidine 75 mg OR Over-the-counter PPI (taken once daily) - Omeprazole 20 mg agent. 

If antacids fail to improve symptoms, recommend ranitidine (Table 44—5). Although most H2 blockers are thought to be safe in pregnancy, ranitidine is the only agent with double-blind, randomized trials evaluating its use in this population.23... 

Ranitidine (Zantac) 150 mg orally twice daily Second-line agent after antacids... 

Bi Bi(sugar) polymers Antiulcer antacid Pepto-Bismol Ranitidine Bismutrex De-Nol... 

Intermittent, mild heartburn Lifestyle modifications plus patient-directed therapy Antacids Maalox or Mylanta 30 mL as needed or after meals and at bedtime Gaviscon 2 tabs after meals and at bedtime Calcium carbonate 500 mg, 2-4 tablets as needed and/or Nonprescription 11 receptor antagonists (taken up to twice daily) Cimetidine 200 mg Famotidine 10 mg Nizatidine 75 mg Ranitidine 75 mg or... 

Drug therapy, if necessary, may be initiated with aluminum, calcium, or magnesium antacids sucralfate or cimetidine or ranitidine. Lansoprazole, omeprazole, and metoclopramide are also options if the patient does not respond to histamine-2 receptor blockers. 

With reference to which classification has the statement, ranitidine is an antacid been given ... 

Why are cimetidine and ranitidine better antacids than sodium hydrogencarbonate or magnesium or aluminium hydroxide ... 

If 10% of patients previously receiving prescriptions for an antacid were prescribed a H2 antagonist such as cimetidine or ranitidine, this claimed savings would not have been achieved. The growth in the H2 antagonist market was rapid at this time, and some of this growth must have been due to such escalation of prescribing. 

Drugs that may affect HMG-CoA reductase inhibitors include alcohol, amiodarone, antacids, azole antifungals, bile acid sequestrants, cimetidine, cyclosporine, diltiazem, erythromycin, gemfibrozil, isradipine, nefazodone, niacin, nicotinic acid, omeprazole, phenytoin, propranolol, protease inhibitors, ranitidine, rifampin, St. John s wort, and verapamil. 

Drugs that may affect benzodiazepines include alcohol, antacids, barbiturates, cimetidine, disulfiram, fluoxetine, isoniazid, ketoconazole, metoprolol, oral contraceptives, narcotics, probenecid, propoxyphene, propranolol, ranitidine, rifampin, scopolamine, theophylline, and valproic acid. 

Deravirdine (Rescnptor) [Antiretroviral/NNRTI] Uses HIV Infxn Action Nonnucleoside RT inhibitor Dose 400 mg PO tid Caution [C, ] CDC recommends HIV-infected mothers not to breast-feed (transmission risk) w/ renal/hepatic impair Contra Use w/ drugs dependent on CYP3A for clearance (Table VI-8) Disp Tabs SE Fat redistribution, immune reconstitution synd, HA, fatigue, rash, T transaminases, N/V/D Interactions T Effects W/ fluoxetine T effects OF benzodiazepines, cisapride, clarithromycin, dapsone, ergotamine, indinavir, lovastatin, midazolam, nifedipine, quinidine, ritonavir, simvastatin, terfena-dine, triazolam, warfarin effects W/ antacids, barbiturates, carbamazepine, cimetidine, famotidine, lansoprazole, nizatidine, phenobarbital, phenytoin, ranitidine, rifabutin, rifampin effects OF didanosine EMS Use of benzodiazepines and CCBs should be avoided may cause a widespread rash located on upper body and arms OD May cause an extension of nl SEs symptomatic and supportive Deferasirox (Exjade) [Iron Chelator] Uses Chronic iron overload d/t transfusion in pts >2 y Action Oral iron chelator Dose Initial 20 mg/kg... 

Do not take ranitidine within 1 hour of magnesium- or aluminum-containing antacids... 

Antacids Tetracyciine, isoniazid, atenoioi, chiorpromazine peniciiiamine, digoxin, ranitidine Decreased absorption... 

Histamine H2-receptor antagonists are well absorbed orally, although concurrent antacid therapy may reduce bioavailability by up to 30%. They are widely distributed in the body, crossing the blood-brain barrier and the placenta. Cimetidine, ranitidine and famotidine are extensively metabolised in the liver, and about one-third excreted unchanged in urine, while only one-third of nizatidine is metabolised (Table 11.1). Elimination half-life is increased up to tenfold in renal failure, and doses must be adjusted. 

Drug Interactions Gemfibrozil Niacin Erythromycin Cholestyramine Digoxin Cimetidine/ranitidine/ omeprazole Rifampicin Warfarin Itraconazole Gemfibrozil Niacin Erythromycin Propranolol Digoxin Warfarin Antacids Colestipol Digoxin Erythromycin Oral contraceptives Fibrates Niacin Azole antifungals... 

Gastrointestinal drugs. Avoid cimetidine and omeprazole which inhibit the clearance of R warfarin, and sucralfate which may impair its absorption. Ranitidine may be used but INR should be checked if the dose is high. Most antacids are safe. 

Earnest D, Robinson M, Rodriguez-Stanley S, Ciociola AA, Jaffe P, Silver MT, Kleoudis CS, Murdock RH. Managing heartburn at the base of the GERD iceberg effervescent ranitidine 150 mg b.d. provides faster and better heartburn relief than antacids. Aliment Pharmacol Ther 2000 14(7) 911-18. 

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